Archive | March, 2011

Recent Increase in Unnecessary Prostate Biopsy

With an increase in attention given to PSA (prostate specific antigen) levels in men in the United States comes an increase in referrals for prostate biopsy.  Oftentimes, these biopsies are recommended even when doctors have no other indications of prostate cancer besides the PSA level.  A new study, however, finds that such prostate biopsies are unnecessary if men have a normal clinical exam and their total PSA levels are not yet high.

“If a man’s PSA has risen rapidly in recent years, there is no cause for concern if his total PSA level is still low and his clinical exam is normal,” said Andrew Vickers, PhD, the lead author of the new study from Memorial Sloan-Kettering Cancer Center.

In this most recent study, 5,519 men who participated in the Prostate Cancer Prevention trial were evaluated.  All the participants were 55 years or older, had no previous history of prostate cancer, and had normal digital rectal findings and PSA levels of 3.0 ng/mL or less.

The men were randomly assigned to take either finasteride (a medication used to treat BPH) or placebo for seven years.  Each year, all the men were screened for PSA levels, and those who had a PSA greater than 4.0 ng/mL were advised to have a prostate biopsy.  At the end of the study, men who did not have prostate cancer were asked if they would consent to a biopsy.

The researchers concluded, after reviewing the study’s results, that the main factor that predicted the risk of cancer was a man’s PSA level, not how rapidly the PSA rose.  Men with a steady PSA of 5 ng/mL were more likely to have prostate cancer than those whose PSA rose from 2.5 to 3.4 ng/mL.  They recommended that a rapidly rising PSA should not be included in screening guidelines for prostate cancer.

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Debunked Prostate Cancer Myths

“As prostate cancer is a major health issue, and not all prostate cancers are the same,” states Dr. Vorstman in his recent article dedicated to correcting patient misunderstandings about prostate cancer and treatment options, “it is vitally important that men and their spouses deal with factual information only.”  Dr. Vorstman is concerned about the emerging prostate cancer myths and is working to inform the public in hopes to shed light on the reality of the disorder.  He explains over 20 myths and the facts about the topics in his recently published article.

One myth has deterred men from seeking medical expertise in regards to their prostates:  If no urinary symptoms are present, then you do not have cancer.  Dr. Vorstman states that most men who are diagnosed with prostate cancer when it is early enough to be treatable actually have no urinary symptoms at all, nor do they  have problems that show up on their examination, but rather are diagnosed entirely through PSA abnormalities.

“This is one of the most damaging myths,” warns the doctor, “as it causes some men to skip the PSA test, and therefore fail to discover their cancer before it is too late for effective treatment.”

While this myth leads to inactivity, other myths over-emphasize PSA numbers.  The PSA test is simply an indication that prostate cancer may be present, but elevated PSA numbers combined with the percent of free PSA can point to the need for a prostate biopsy.  The biopsy is what determines whether or not the prostate contains cancer.  The PSA test itself is simply the first step in the diagnostic process.  This means that men with low PSA numbers can still have prostate cancer.  In fact, because of this, Dr. Vorstman recommends checking the percent free PSA and doing a digital rectal exam for all patients, regardless of their PSA number.

Yet another common myth comes with strong advertising.  This myth suggests that certain supplements will prevent prostate cancer.  Although no danger exists for taking vitamins and such supplements may promote overall health, science has not yet proved that supplements or other dietary changes actually lower a man’s risk for cancer.

Finally, Dr. Vorstman warns against myths surrounding prostate cancer treatment.  In the past, prostate cancer was often universally treated with surgery.  Many believe this is still the case today; however, according to Dr. Vorstman, “This is no longer true with the wide range of minimally invasive prostate cancer treatments on the market.  Today’s patient can protect his quality of life while successfully treating prostate cancer without surgery, so it is vital that he and his spouse look at all of the options.”

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Robot Prostate Surgery Requires More Skill and Training

Robotic-assisted prostate cancer surgery is not as easy as the medical media originally made it out to be, researchers suggest.

Doctors who perform the surgery are not 100% proficient the first time.  In fact, it is estimated that doctors need to perform the surgery more than 1,600 times before becoming proficient and are able to remove all the malignant cells surrounding the tumor.

But results from a study suggest that the Intuitive Surgical Inc.’s da Vinci robot is being used too often at community hospitals by surgeons who do not have enough experience, said Prasanna Sooriakumaran, lead author and urologist at the Weill Cornell Medical College in New York.  Until recently, doctors have preferred the approach because past studies show it can be learned quickly, use smaller incisions, cause less blood loss, and speed recovery.

More than 90,000 men in the U.S. have their prostate gland removed each year because of cancer, according to the American Society of Clinical Oncology.  The surgery is done mainly with robotic technology introduced in 2000 by Intuitive Surgical, typically by doctors who perform 100 or fewer procedures annually, said Sooriakumaran.

“The operation is not easy to perform and it takes a lot of experience in order to get the best results for our patients,” he explained.  “The enthusiasm in the United States needs to be tempered in terms of what sort of hospital needs to be purchasing this equipment and what sort of surgeons should be allowed to do these operations.”

The recent study on the proficiency of doctors using the robotic-assisted surgery focused on three surgeons learning the technique over a six-year period at high-volume centers at the University of Pennsylvania in Philadelphia, Karolinska Institute in Stockholm, and Weill Cornell in New York City.  The researchers found that surgery times decreased with each operation, while the doctor’s ability to remove all the cancer increased, Sooriakumaran said.

The surgeons needed to perform more than 1,600 operations before they were able to gauge with at least 90 percent accuracy how much tissue surrounding the tumor they needed to remove to get all the malignant cells.  This is important as leaving stray cancerous cells in the margins, at the edge of the tissue removed during surgery, can lead to recurrences of the disease.

Calvin Darling, a spokesman for Intuitive Surgical, explained that one barrier is that every hospital has its own system to train surgeons and it’s not up to the company to determine when the doctors reach proficiency.

“The average time it takes to get to proficiency as defined by our hospitals in their training protocols is typically mid-double digits,” he said.  “This [the study’s results] is an order of magnitude higher.”

Sooriakumaran’s complaint is that the procedure needs to be centralized so that surgeons can get the amount of experience needed to gain the best results for their patients.  While more than 700 operations a year are done in medical centers that specialize in the surgery, community-based hospitals only get a handful a month, leading to less experienced surgeons in these smaller hospitals.

The use of robotic technology is growing exponentially, said Nicholas Vogelzang, an oncologist at the Comprehensive Cancer Centers of Nevada in Las Vegas and chair of U.S. Oncology’s developmental therapeutics committee.  Doctors need to ensure their abilities are keeping up, he said.

“This data today will make everyone pause,” said Vogelzang, who pointed out that traditional open surgery also requires years of practice.  “Maybe it’s time to go a little bit farther before we rush into this surgery.  Experience really does matter.”

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Trapping Prostate Cancer with Nanomaterials

A team of researchers from across the world have developed nano-sized, self assembling nanomaterials made of peptides (SAP).  The cultures were then used to house prostate cancer stem cells.

Not only did the SAP stop cancer stem cells from growing, but it also prevented them from dividing further in vitro.  Further, when the cells were taken out of the SAP encasing they began to grow and multiply.

The results of these experiments have been published in the recent issue of Cell Transplantation.  The importance of cancer stem cells is that they could lead to prostate tumor metastasis.  If these cells could be prevented from developing further, then they are a perfect target for stopping disease metastasis.  The team had earlier shown that it was possible to control the growth, spread and maturation of cells in vitro by using SAPSs.  Dr. Rutledge Ellis-Behnke of the Heidelberg University-based Nanomedicine Translational Think Tank, who wrote the paper, said that it is possible to keep the cells in stasis for prolonged periods without causing separation.  The cells could be treated further if they could be held in one place.

According to the team of researchers, this experiment has proved that cancer stem cells could prevail within a tumor.  If chemotherapy was not working and cancer stem cells were not responding to the drugs, then the treatment may be unsuccessful.  But the metastatic cells could be prevented from spreading by injecting the substance into the tumor.

Researchers believe that imprisoning the cancer stem cells in the nanomaterial could integrate the SAP into the chemotherapy drug and make the localized treatment more effective because it would prevent the cancer cells from escaping from the chemicals.

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A Review on Diet and Prostate Cancer

After lung cancer, prostate cancer is the second leading cause of cancer deaths in men.  The older the men get, the higher the occurrence of the disease.

If you have prostate cancer or want to prevent prostate cancer there are numerous information that has looked at diet and prostate cancer.  Although some data are compelling, there is still so much to learn about diet and prostate cancer.

You might have already come across the tips below; it might not most likely reduce your risk to the disease but it should improve your health in general.

1. Maintain a diet rich in vegetables, fruits and whole grain.

Cruciferous vegetables such as broccoli, cabbage and cauliflower reduced the risk of prostate cancer by 41% according to a new study from the Fred Hutchinson Cancer Research Center in Seattle. These vegetables boast two phytochemicals which are thought to help deactivate cancer-causing substances. Lycopene present in tomatoes and other red fruits have been linked to lower risk of prostate cancer. A tablespoon of ground flaxseed a day contributes to 3 grams of fiber along with healthy omega-3 fatty acids, phytoestrogens and phytochemicals.

2. Stay away from red meat and refined/processed carbohydrates.

Eat fish a couple of times a week instead.  Fish have the so called long chain omega-3 which helps stop the development of cancer.  Saturated fats in animal meats and dairy products and processed foods that use hydrogenated fats/oils may help promote prostate cancer.

3. Engage in moderate intensity physically active at least 30 minutes a day.

You can also engage in vigorous-intensity physical activity at least 20 minutes on three or more days of the week. One recent study suggested that regular vigorous activity could slow the progression of prostate cancer in men age 65 or older

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Use Caution When Deciding on HIFU

Normally, high-intensity focused ultrasound (HIFU) is used as a salvage treatment for prostate cancer.  Recently, a movement has taken place to push HIFU as a front-line use, but both the US Food and Drug Administration and the European Association of Urology classify the procedure as experimental.

The first case series to report outcomes in men after failed whole-gland HIFU and salvage radical prostatectomy suggests that there is reason for caution.

Researchers report they were alarmed at the pathology results.  Morbidity appeared to be higher after salvage prostatectomy than after primary surgery.

Declan G. Murphy, MD, from the Department of Urological Oncology at the Peter MacCallum Cancer Centre in Melbourne, Australia, notes, “Whether it is that standard prostate biopsy cannot be relied on to predict final pathological outcome, or that HIFU ‘makes cancer angry,’ patients should be fully counseled about what we know and, importantly, what we do not know about HIFU treatment for localized prostate cancer today.”

“Our own initial experience with HIFU treatment for primary and recurrent prostate cancer unfortunately led us to conclude that the technology is not yet suitable for mainstream clinical practice, and led us to suspend our program,“ Dr. Murphy added.

Dr. Lawrentschuk believes that using radical prostatectomy as salvage treatment after the failure of primary HIFU is feasible; however, he is concerned about the rate of extraprostatic extension.

“HIFU is experimental and should only be done in studies where patients are told of the risks of failure and the poor results of salvage.  They need very careful monitoring, follow-up biopsies, etc.  I do not advise patients to have HIFU.  There may be a problem with HIFU selecting out more aggressive cells, but this warrants further study,” explains Dr. Lawrentschuk.

“Experimental treatments are fraught with danger.  I was surprised at the aggressive nature of the disease and the recurrences in this supposedly low-risk group,” he continues.  “I think HIFU is inadequate in its current form, perhaps because of poor patient selection for HIFU and a lack of standardized ways of detecting post-HIFU recurrences in a timely fashion.”

Howard Sandler, MD, chair of radiation oncology at Cedars-Sinai Medical Center’s Samuel Oschin Comprehensive Cancer Institute in Los Angeles, California, also reviewed the study.

“I wouldn’t conclude that the high number with extracapsular extension is a result of HIFU.  It is more likely that patients who fail HIFU had worse cancers in any case from the start.  Additionally, there may have been a bit of a delay after some suspicion of recurrence before salvage surgery was done, given the presurgery PSA [prostate-specific antigen] of 3.8, with the nadir PSA of 1.0.  Thus, patients waited on average for their PSA to rise from 1.0 to 3.8 before something was done.  During this interval, extracapsular extension may have occurred,” Dr. Sandler explained.

Overall, Dr. Sandler believes that HIFU is a poor choice for whole-gland ablation and focal therapy.

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Coffee and Prostate Health: Is it Bad for You?

Is coffee good or bad for men’s health?  A recent study suggests that coffee and caffeine may be safe (for now) in regards to prostate cancer, but components within coffee can negatively affect men who have benign prostatic hyperplasia (BPH).

For men who have BPH, drinking coffee can be detrimental because caffeine can stimulate an already overactive bladder, which means it can increase urinary frequency and urgency and may even result in urge incontinence.  Caffeine acts on the bladder in several ways.  First, it increases how fast the bladder fills up by increasing the rate of urine production.  Second, caffeine enhances the sensation and contractility of the bladder, thus making the organ feel a potentially erroneous urge to empty.

Caffeine can also irritate the bladder because it is a theoxanthine, which is a family of drugs that includes theobromine (found in chocolate) and theophylline (found in tea).  Theophylline also stimulates and irritates the bladder; however, tea contains half as much caffeine as coffee does, and green tea specifically contains even less.

The impacts of coffee on prostate cancer have piqued the interests of researchers worldwide.  According to recent research conducted by Dr. Chang-Hae Park from the National Cancer Center in South Korea, there is no association between prostate cancer and drinking coffee, but there is still some controversy.  Park and his team evaluated the results of 12 studies that compared coffee intake and prostate cancer risk.  Eight of the studies were case-control studies and four were cohort studies.

The controversial part is that although the investigators found a significant harmful association between coffee consumption and prostate cancer risk in seven of the eight case-control studies, they also explained that the studies had severe limitations that affected the outcomes.  None of the cohort studies showed any significant association between coffee consumption and prostate cancer.  Therefore, while Park and his team reported there is no evidence that coffee consumption has an effect on prostate cancer, further prospective cohort studies are needed.

The journal Molecular Nutrition and Food Research published a study in 2009 in which researchers evaluated the impact of coffee and tea on prostate health.  The investigators’ results showed that no apparent relationship with prostate cancer existed; however, the evidence from animal and in vitro studies suggested that tea, especially green tea, is a healthier choice than coffee for prostate health.

A study at Umea University in Sweden analyzed the effects of both filtered and boiled coffee on the incident of cancer.  From a study population of more than 64,000, there were 3,034 cases of cancer, with up to 15 years of follow-up.  The investigators did not find an association between consumption of filtered or boiled coffee and all types of cancer combined, or for prostate or colorectal cancer in particular.

Another large study conducted by Harvard evaluated 50,000 men.  Researchers used data from the Health professionals’ follow-up study to determine if there was an association between the consumption of regular and decaffeinated coffee and prostate cancer.  The investigators found that over two decades, 4,975 cases of prostate cancer were diagnosed.  According to Kathryn Wilson, Ph.D., from Harvard Medical School and the Harvard School of Public Health, she and her team “specifically looked at different types of prostate cancer, such as advanced vs. localized cancers or high-grade vs. low-grade cancer.”  They found that men who had the highest intake of coffee had a 60 percent lower risk of advanced prostate cancer.  Wilson noted:  “Our results do suggest there is no reason to stop drinking coffee out of any concern about prostate cancer.”

Coffee and caffeine have an impact on other aspects of your health outside of prostate health.  Some studies suggest that consuming coffee and caffeine is associated with a reduced risk of certain diseases.  One study published in Cancer Causes & Control in January 2011 found that drinking three or more cups of coffee daily was associated with a 44 percent reduced risk of developing liver cancer in a group of older Chinese adults.

In addition, the Journal of Alzheimer’s Disease reported the results of a recent review study that explored a relationship between coffee and dementia.  The investigators concluded that coffee drinking may be associated with a reduced risk of dementia and Alzheimer’s disease.

But despite these positive studies, a combination of coffee, caffeine, and stress can be very unhealthy.  Here are some reasons why these three don’t always mix well.

  1. Coffee raises stress hormone levels.  Elevated levels of stress hormones, including norepinephrine and especially cortisol, are responsible for raising heart rate and blood pressure.  When you combine coffee/caffeine with stress, you place your stress hormones on high alert, which in turn puts your heart rate and blood pressure in unhealthy states as well.  Elevated stress hormones also weaken your immune system.  If you reduce your coffee/caffeine consumption, you will lower your stress hormone levels, blood pressure, and heart rate, and help preserve your immune system health.
  2. Coffee contributes to weight gain.  The higher cortisol levels associated with coffee consumption are also linked to insulin resistance, increased appetite, and cravings for fatty foods.  High cortisol levels can also contribute to fat deposits in the abdomen, which is a risk factor for heart disease.
  3. Coffee plus stress may equal heart attack.  Coffee consumption can increase stress, which is a known risk factor for heart attack, heart palpitations, and elevated homocysteine, another risk factor for heart disease.  If you are stressed, coffee is not a health beverage for your heart.
  4. Stress and coffee affect the brain.  Stress has a detrimental effect on the parts of the brain responsible for planning, decision making, and reasoning.  When you add caffeine, your mental abilities, mood, and memory can suffer, because caffeine interferes with blood flow to the brain.  To keep mentally sharp, reduce your use of coffee and caffeine.
  5. Stress and coffee disrupt sleep.  Stress and worry can keep you awake, and the stimulating effects of caffeine can disrupt your ability to sleep.  If you eliminate coffee, you may regain the ability to sleep.
  6. Stress and coffee irritate your GI tract.  Coffee and caffeine are highly acidic, which can increase the risk of heartburn, ulcers, and irritable bowel syndrome.  Reduce your coffee intake, and reduce your risk of these gastrointestinal problems.

An occasional cup of coffee will not likely have a negative effect on prostate health or your overall health.  But if you have BPH, coffee consumption should be limited.  If you want to enhance prostate health and general well-being, however, the better choice is green tea.

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Delaying Prostate Cancer the Right Way

For the first time ever, researchers are conducting a study that focuses on changing a man’s entire lifestyle in order to delay the progression of prostate cancer.

The study uses dietary changes, exercise, and telephone counseling in order to stop or delay the progression of prostate cancer, announced UC San Diego Moores Cancer Center.

Male participants in the Men’s Eating and Living Study will eat at least seven servings of vegetables like kale and broccoli per day, along with tomato products, whole grains, beans, and fruit.

Scientists have known that a healthy diet rich in vegetables and low in meat and fat is associated with a reduced risk in prostate cancer.  Dr. J. Kellogg Parsons, a urologic oncologist at the Moores Cancer Center, said previous studies already have shown that such a diet may prevent the progression of prostate cancer, or even the development in the first place.

But, he says, “Ours is the first study to focus on changing the entire lifestyle rather than just giving the participants a supplement pill.”

“We focus on more vegetables, less meat, and comprehensive counseling which encourages a more active lifestyle.”

The study’s goals couldn’t come at a better time.  Nearly 100,000 American men are diagnosed annually with early-stage, low-risk prostate cancer.  And Dr. Kellogg believes too many of these men have overly aggressive treatment that reduces their quality of life.

Participants who qualify for the study are males up to 80 years old who have been diagnosed with non-aggressive prostate cancer within the last two years, are in the early stages, and have not yet received treatment of any kind.

The study’s researchers hope to show whether or not cancer can be controlled in its early stages without surgery or radiation.

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Pomegranates and PSA Scores

Recent studies on the effects of pomegranate extract on prostate cancer have yielded mixed results.  In one study, which focused on prostate-specific antigen levels, pomegranate extract slowed the PSA doubling time by more than 6 months in a broad population of patients with prostate cancer; however, some evidence suggests that it may accelerate the disease for some individuals.

Overall, the median pretreatment PSA doubling time (PSADT) increased significantly from 11.9 months to 18.5 months post treatment among 92 evaluable men with a rising PSA after primary therapy in the phase II, double-blind, multicenter study.

The increase in median PSADT was similar whether the men were randomized to one capsule daily (from 11.9 to 18 months) or to three capsules daily (from 12.2 to 17.5 months).  A negative PSA slope, suggesting declining PSA values, was observed in 13% of patients, reported Dr. Michael Carducci, a professor of oncology and urology at Johns Hopkins University in Baltimore.

Nearly 20% of the population, however, had their PSADTs shortened, leading to treatment discontinuation.

“There is an apparent benefit across all PSA doubling times, although some shortening of PSA doubling time was seen,” stated Dr. Carducci at the Genitourinary Cancers Symposium.

Dr. Michael J. Morris of Memorial Sloan-Kettering Cancer Center in New York indicated that a more prospective evaluation of the study’s results was necessary.

“If you believe that prolonged PSA doubling time is clinically beneficial, what do we say about patients whose disease appears to accelerate as a result of taking the pomegranate extract?” he asked.  “Do we say or suggest that a third to 40% of patients might be done some harm, or might have an earlier clinical end point?  I don’t know, but I think that’s an issue of concern.”

One limitation of the pomegranate study, acknowledged by Dr. Carducci, is that it lacked a placebo.  A number of reports in the literature, including studies of rosiglitazone (Avandia) and atrasentan (Xinlay), have shown that even a placebo can slow PSADT.

“We did not have a placebo, so [these data are not] definitive and could be explained by on-study regression to the mean,” he said, noting that data should be available in the near future from a 200-patient, placebo-controlled trial of pomegranate extract liquid.

Current laboratory data also shows that pomegranate extract is more effective at controlling the growth of prostate cancer than is pomegranate juice in prostate cancer cell lines, but this comparison has not been tested in patients, explained Dr. Carducci.

The 101 men in the intent-to-treat analysis had a medial Gleason score of 7, and about one-third of them had a baseline PSADT of 9 months or less.  The men were treated for up to 6 months (92% of patients), 12 months (70%), or 18 months (36%) with capsules containing 1,000 mg of pomegranate juice.  In all, 58% of patients completed the 18-month, double-blind portion of the study, and 42% discontinued treatment before progression.

Ultimately, the decision to use pomegranate extract or juice is a matter of discussion between physician and patient, concluded Dr. Carducci.

“I think with two consistent data sets showing slowing PSA doubling time, it would be reasonable for a patient to consider and understand what he’s getting himself into.  It’s possible that patients with slower growing disease may have the greater benefit.”

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Elective Surgery Options Depend on Your Doctor

Who your doctors are and where they practice medicine determine how their patients are treated in the United States, according to researchers.

A new study focused on elective procedures for patients over 65 and who were covered by Medicare.  The study found a number of regional differences in the way U.S. doctors treat patients, suggesting that patient preferences are often being ignored.

“These striking variations are the by-product of a doctor-centric medical delivery system,” Shannon Brownlee of the Dartmouth Institute for Health Policy and Clinical Practice, who led the study, said.

For example, a man living in San Luis Obispo, California, is 12 times more likely to have elective surgery to remove his prostate than a man in Albany, Georgia.

The Dartmouth Atlas Project led this most recent study, as well as many other studies that have found regional differences in healthcare across the country.

In addition to regional variances in treatment options offered to their patients, the researchers in the project have also found varying rates of spending by region for elective procedures such as breast cancer, coronary artery bypass surgery, back surgery, knee and hip joint replacement, radical prostatectomy for prostate cancer, and even prostate cancer screening.

“What we find is physicians differ very strongly in their opinions about the value of these procedures,” said Dr. David Goodman, co-leader of the Dartmouth Atlas Project.

“There are regional differences or differences in cultures of care that develop partly related to how physicians are trained or the history of the place.”

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